In the prospective randomized double blind and placebo controlled MIRROR study, peri- and postinterventional dual antithrombotic therapy using acetylsalicylic acid (ASA) and clopidogrel was compared with treatment consisting of ASA and placebo, in patients with infrainguinal peripheral arterial vascular disease treated by endovascular intervention (percutaneous transluminal angioplasty (PTA) or stent. Patients who received dual antithrombotic therapy peri-interventionally as well as for six months after the intervention had a significantly lower repeat intervention rate at the treated vascular section after 6 months (1). The groups were not different regarding complications; in particular, no higher rate in bleeding complications was seen in the clopidogrel arm.

After the study medication was stopped after 6 months as planned, no difference in intervention rates was seen between the groups at 12 months (2).

Even though the number of cases was small (n=80), the trial provided initial evidence in support of dual antithrombotic peri-interventional and postinterventional therapy after interventional treatment of peripheral arterial vascular disease. In our opinion, dual antithrombotic therapy seems worth recommending for 6 months after intervention for peripheral arterial vascular disease (PTA or stent). It remains to be seen if a longer duration of dual therapy—for example, for 12 months—would make sense (as is usual in interventions involving the coronary arteries) or whether new antithrombotic substances may yield a further positive effect.